Arsenic Trioxide

INTRODUCTION

Indications

Induction of remission and consolidation in patients with acute promyelocytic leukemia (APL) who do not respond to or tolerate retinoid and anthracycline chemotherapy and whose disease is associated with the presence of the t(15; 17) translocation or PML/RAR-alpha gene expression.

Action

Alters DNA and fusion proteins in leukemic cells. Therapeutic Effects: Improved hematologic parameters in patients with APL.

Adverse Reactions/Side Effects

CNS: fatigue, headache, insomnia, weakness. Resp: hypoxia, dyspnea, pleural effusion. CV: QT PROLONGATION, COMPLETE AV BLOCK, atrial arrhythmias. GI: abdominal pain, constipation, increase liver enzymes. GU: renal failure. Derm: dermatitis. Endo: hyperglycemia, hypoglycemia. F and E: acidosis, hypocalcemia, hyperkalemia, hypokalemia, hypomagnesemia. Hemat: NEUTROPENIA, APL DIFFERENTIATION SYNDROME, DISSEMINATED INTRAVASCULAR COAGULATION, THROMBOCYTOPENIA, hyperleukocytosis, anemia, leukocytosis. MS: back pain, arthralgia, bone pain, neck pain, limb pain, myalgia. Misc: allergic reactions, fever, infection/sepsis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Be alert for signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), disseminated intravascular coagulation (excessive bleeding from surgical wounds or hemorrhage from the mouth, nose rectum, vagina), or unusual weakness and fatigue that might be due to other anemias or leukemias, including acute promyelocytic leukemia (APL) differentiation syndrome. Report these signs to the physician or nursing staff immediately.

• Assess any breathing problems or signs of pleural effusion (chest pain, cough, shortness of breath, rapid shallow breathing) or hypoxia (pale or blue skin, confusion, fatigue, headache). Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

• Monitor neuromuscular signs of acid-base or electrolyte imbalances (acidosis, hypocalcemia, hypokalemia), including lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Assess any muscle, joint, or bone pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug ...